Mank v. Green

368 F. Supp. 2d 102, 35 Employee Benefits Cas. (BNA) 1102, 2005 U.S. Dist. LEXIS 7505, 2005 WL 758177
CourtDistrict Court, D. Maine
DecidedMarch 29, 2005
DocketCIV.03-42-P-C
StatusPublished
Cited by1 cases

This text of 368 F. Supp. 2d 102 (Mank v. Green) is published on Counsel Stack Legal Research, covering District Court, D. Maine primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Mank v. Green, 368 F. Supp. 2d 102, 35 Employee Benefits Cas. (BNA) 1102, 2005 U.S. Dist. LEXIS 7505, 2005 WL 758177 (D. Me. 2005).

Opinion

MEMORANDUM OF DECISION AND ORDER GRANTING DEFENDANTS’ RENEWED MOTION FOR SUMMARY JUDGMENT ON COUNT III

GENE CARTER, Senior District Judge.

Plaintiff brings this action pursuant to the Employee Retirement Income Security Act of 1974 (“ERISA”), 29 U.S.C. § 1001 et seq. (Counts I, II, III), federal common law (Counts IV, V, VI, VII), and state common law (Counts VIII, IX, X, XI) against Defendants Ellen Green, Lloyd Green, and their attorneys, Jack H. Simmons and the law firm of Berman & Simmons, P.A. seeking to recover $141,335.75 that was paid by the Hannaford Health Plan for Mrs. Green’s accident-related medical expenses. See Amended Complaint and Request for Injunctive Relief (“Amended Complaint”) (Docket Item No. 64). The Court has already granted summary judgment or dismissed all claims except Count III (Docket Item Nos. 127 and 153). On the claims against the Greens, which the Court has already adjudicated, the Plan has recovered $83,941.21 in identifiable proceeds. See Docket Item No. 177. In Count III, Plaintiff does, not allege that Defendants are in violation of any substantive provisions of ERISA; rather she contends that they have violated the terms of the Plan. The Plan now seeks through Count III to recover the remaining $57,394.54 from the attorneys’ fee paid to Attorney Simmons and Berman & Simmons.

I. FACTS

Plaintiff Karen Mank is the Plan Administrator for the Hannaford Health Plan (“the Plan” or “the Health Plan”), which is a self-funded “employee welfare benefit plan” within the meaning of ERISA. Hannaford Bros. Co. and its subsidiaries are involved in the distribution and retail sale of food, prescription drugs and related products through supermarkets and other retail locations in New England as well as other regions of the United States.. Among the benefits that it offers its employees, Hannaford provides health benefits that are designed to assist its employees (and their eligible dependents and domestic partners) in obtaining appropriate health care for a wide variety of conditions. Ellen Green is an employee of Hannaford, and is a participant in, and beneficiary of, the Plan. 1

On June 18, 2001, Mrs. Green was seriously injured when, as a pedestrian, she was struck by a motor vehicle. Mrs. Green incurred significant medical expenses arising from her injuries suffered in the accident. 2 The Plan paid $141,335.75 in medical benefits on behalf of Mrs. Green arising from her injuries suffered in the accident. Second Mank Aff. at ¶ 6. At the time of the accident, the Plan’s right of recovery provisions read as follows:

If the amount of benefit payments made by the Plan is more than should have been paid under the Plan, or if payments are made by a third party with respect *105 to a Covered Person, the Plan shall have the right to recover the excess from the persons it has paid or for whom it has paid or from any other group health plan to which the Plan was secondary under the provisions of Article VI,
A Covered Person who recovers payment from a third party shall reimburse the Plan for the amount of benefit payments made, in full and without reduction for attorneys’ fees or costs, from the proceeds received from the third party, whether the proceeds are paid by way of settlement, judgment, or otherwise, and the Plan shall have an equitable interest in the amount recovered, or to be recovered, for the amount of benefit payments made.
The Plan shall have the right to withhold future benefit payments to which a claimant or a Covered Person through whom the claimant derives his or her claim may be entitled until the obligation to the Plan under the foregoing provisions of'this Section, plus interest, has been satisfied. This right to offset shall not limit the right of the Plan to recover an erroneous or excess payment in any other manner, and the Plan shall equally have the right to institute legal action against a Covered Person for failure to reimburse the Plan or to honor its equitable interest in the amount recovered from a third party, and the Covered Person shall be liable in such event for all costs of collection, including reasonable attorneys’ fees.
For purposes of this Section, the “amount of benefit payments made” shall include. in appropriate cases the reasonable cash value of any benefits provided in the form of services.

Second Mank Aff. Ex. 1.

The Greens retained Attorney Jack E. Simmons and the law firm of Berman & Simmons, P.A. to represent them in a legal claim against the third-party who caused her injuries. 3 On June 20, 2001, two days after the accident, Lloyd Green,- Ellen Green’s husband, met with Attorney Simmons. Fourth Affidavit of Seth Brewster (Docket Item No. 164) Ex. 2, at BS 266. In that meeting, Mr. Green described the accident and. informed Attorney Simmons that Mrs. Green received her health benefits through her employer Hannaford. Id. at BS 269. On July 2, 2002, Attorney Simmons met with Ellen Green to discuss the accident and the accident investigation. Id. at BS 270-273. At that time, Ellen Green executed a Contingent Fee Agreement with Berman & Simmons. 4 Id. Ex. 3.

Sometime in July 2001, the Plan sent Mrs. Green a form to complete relating to her accident. On July 31, 2001, Mrs. Green completed the form that provided the requested information to, the Plan, including the name and address of her attorney, as well as the name and address of the insurance company for the owner of the vehicle that hit her. Affidavit of Ellen Green (Docket Item No. 53), at ¶¶3-4. Specifically, Mrs. Green signed the document acknowledging as follows:

*106 I/We am/are aware of the right of recovery provision contained in the Plan. I/We express my/our agreement to be bound by the provision. I/We understand, however, that my/our failure to express such agreement shall in no way affect the rights of the Company under the provision. I/We further agree that I/We shall not do anything to prejudice the rights of the Company in this matter.

Fourth Brewster Aff. Ex. 34, BS 117.

On October 3, 2001, Mrs. Green completed another information form relating to her accident in which she again provided to the Plan the name and address of her attorney, as well as the name and address of the insurance company for the owner of the vehicle that hit her. Mrs. Green again signed the form acknowledging the Plan’s right of recovery. Id. at BS 118.

In an effort to establish the seriousness of Mrs. Green’s injuries and to facilitate settlement of the Greens’ claims, Attorney Simmons sent a list of medical charges totaling $68,850.29 from Central Maine Medical' Center to the insurance company representing the owner and driver of the vehicle that hit Mrs'. Green. 5 Brewster Aff. IV, Exs. 13, 14.

Free access — add to your briefcase to read the full text and ask questions with AI

Related

Cite This Page — Counsel Stack

Bluebook (online)
368 F. Supp. 2d 102, 35 Employee Benefits Cas. (BNA) 1102, 2005 U.S. Dist. LEXIS 7505, 2005 WL 758177, Counsel Stack Legal Research, https://law.counselstack.com/opinion/mank-v-green-med-2005.